Cardiac Surgery
PCI vs. CABG in left main coronary disease patients with and without diabetes—a pooled analysis of 4 trials
22 Mar, 2024 | 11:41h | UTCStudy Design and Population: This research pooled individual patient data from four randomized clinical trials (SYNTAX, PRECOMBAT, NOBLE, and EXCEL), comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in 4393 patients with left main coronary artery disease. The trials included both patients with and without diabetes, allowing for a comparative analysis of outcomes based on the revascularization method and the presence of diabetes.
Main Findings: Patients with diabetes exhibited higher rates of 5-year mortality, spontaneous myocardial infarction (MI), and repeat revascularization compared to those without diabetes. However, mortality rates following PCI vs. CABG were similar in diabetic (15.3% vs. 14.1%, respectively) and non-diabetic patients (9.7% vs. 8.9%, respectively). PCI was associated with a lower risk of stroke within the first year post-operation across all patients. Notably, diabetic patients underwent higher rates of spontaneous MI and repeat revascularization after PCI compared to CABG, with a more significant absolute excess risk observed beyond the first year compared to non-diabetic patients.
Implications for Practice: For patients with left main disease deemed suitable for either PCI or CABG, diabetes status significantly influences long-term outcomes, including death and cardiovascular events. While PCI offers a lower early risk of stroke, it is associated with increased risks of spontaneous MI and repeat revascularization, particularly in diabetic patients. These findings underscore the importance of considering patient-specific factors, such as diabetes status, in choosing between PCI and CABG for left main coronary artery disease revascularization.
Reference
Prakriti Gaba et al. (2024). Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With or Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials. Circulation, 0. DOI: 10.1161/CIRCULATIONAHA.123.065571. Access the study here: Link
Case Report | Post-myocardial infarction free-wall rupture: rapid diagnosis and management
2 Aug, 2023 | 13:52h | UTCPost-Myocardial Infarction Free-Wall Rupture: Rapid Diagnosis and Management – JACC: Case Reports
Commentary on Twitter
Learn how to evaluate, diagnose and manage #cvMI wall rupture to improve survival in #JACCCaseReports' latest issue: https://t.co/aGPJ1rZ8eu#CardioTwitter #cvSurg #CathLab pic.twitter.com/bPTtJownNf
— JACC Journals (@JACCJournals) July 31, 2023
Study | Left ventricular dysfunction in brain-dead heart donors – incidence, reversibility, and implications
31 Jul, 2023 | 14:09h | UTCLeft Ventricular Dysfunction Associated With Brain Death: Results From the Donor Heart Study – Circulation (free for a limited period)
Pooled Analysis | Post-CABG graft failure found in 33.7% of patients, strongly linked to cardiac events
20 Jul, 2023 | 11:03h | UTCGraft Failure After Coronary Artery Bypass Grafting and Its Association With Patient Characteristics and Clinical Events: A Pooled Individual Patient Data Analysis of Clinical Trials With Imaging Follow-Up – Circulation (free for a limited period)
Commentary on Twitter
#OriginalResearch: In this analysis pooling individual level data from randomized trails, graft failure occured in 34% of patients undergoing CABG and was associated w/ increased risk of adverse clinical events #AHAJournals @WCM_CTSurgery https://t.co/Vg7t56pg0x pic.twitter.com/gmseiefME0
— Circulation (@CircAHA) July 18, 2023
AHA Statement | Indications, evaluation, and outcomes for dual heart-kidney and heart-liver transplantation
14 Jul, 2023 | 12:51h | UTC
Consensus Paper | Adult cardiac surgery-associated acute kidney injury
7 Jul, 2023 | 16:18h | UTC
AHA Scientific Statement | Considerations on the management of acute postoperative ischemia after cardiac surgery
29 Jun, 2023 | 14:07h | UTC
Editorial | How to become a good surgeon
22 Jun, 2023 | 15:12h | UTCHow to become a good surgeon – Advances in Ophthalmology Practice and Research
RCT | No superior recovery with minithoracotomy over sternotomy in mitral valve repair
20 Jun, 2023 | 12:51h | UTCMinithoracotomy vs Conventional Sternotomy for Mitral Valve Repair: A Randomized Clinical Trial – JAMA (free for a limited period)
See also: Visual Abstract
M-A | Similar death rates in left main disease patients treated with PCI or CABG, both in patients with and without ACS
15 Jun, 2023 | 14:59h | UTCPercutaneous Coronary Intervention vs Coronary Artery Bypass Graft Surgery for Left Main Disease in Patients With and Without Acute Coronary Syndromes: A Pooled Analysis of 4 Randomized Clinical Trials – JAMA Cardiology (link to abstract – $ for full-text)
Commentary: CABG and PCI Comparable in ACS Patients With Left Main CAD – TCTMD
RCT | Noninferior survival rates with hearts donated after circulatory death versus brain death
12 Jun, 2023 | 13:57h | UTCTransplantation Outcomes with Donor Hearts after Circulatory Death – New England Journal of Medicine (link to abstract – $ for full-text)
Video summary: Outcomes with Donor Hearts after Circulatory Death | NEJM
News Release: Multicenter Trial Finds Using Circulatory Death Donors is Safe and Effective for Heart Transplantation – Northwestern Medicine
Commentary: Transplantation Outcomes With Donor Hearts After Circulatory Death – American College of Cardiology
Commentary on Twitter
In a randomized trial, survival at 6 months after transplantation with hearts donated after circulatory death was noninferior to that with hearts donated after brain death. https://t.co/IymsknTqSE#cardiology pic.twitter.com/oYAS10fVJt
— NEJM (@NEJM) June 7, 2023
M-A | Accuracy of diagnostic tests in cardiac injury after blunt chest trauma
6 Jun, 2023 | 14:15h | UTC
Quality-improvement intervention | Impact of stopping preoperative screening for asymptomatic bacteriuria
2 Jun, 2023 | 12:29h | UTCCommentary: Hospital intervention reduces unnecessary screening, antibiotics for bacteriuria – CIDRAP
RCT | High-dose statin loading prior to CABG shows no benefit in major cardiac and cerebrovascular events
11 May, 2023 | 12:10h | UTCStatin loading before coronary artery bypass grafting: a randomized trial – European Heart Journal (link to abstract – $ for full-text)
Commentary: Statin Loading No Help Before Bypass Surgery: StaRT-CABG – TCTMD
Commentary on Twitter
Statin loading before coronary artery bypass grafting: a randomised trial https://t.co/br15X5lf7k @escardio #EHJ #ESCYoung @rladeiraslopes @ehj_ed pic.twitter.com/aQFlsJfaed
— European Society of Cardiology Journals (@ESC_Journals) May 8, 2023
M-A | Posterior pericardiotomy reduces the risk of atrial fibrillation after cardiac surgery
22 Mar, 2023 | 13:18h | UTCPosterior pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of 25 randomised controlled trials – EuroIntervention (link to abstract – $ for full-text)
Related:
Consensus Paper | Pain management and opioid stewardship in adult cardiac surgery
8 Mar, 2023 | 14:22h | UTC
M-A | Effect of posterior pericardiotomy in cardiac surgery
28 Feb, 2023 | 13:34h | UTC
Guideline Synopsis | Management of thoracic aortic dissection
21 Feb, 2023 | 11:48h | UTCManagement of Thoracic Aortic Dissection – JAMA (free for a limited period)
Original Guidelines:
Review | Postoperative atrial fibrillation: from mechanisms to treatment
15 Feb, 2023 | 15:54h | UTCPostoperative atrial fibrillation: from mechanisms to treatment – European Journal of Cardiology
Commentary on Twitter
Postoperative atrial fibrillation: from mechanisms to treatment https://t.co/Alpb9eFRGb @escardio #EHJ #ESCYoung #cardiotwitter @ehj_ed @rladeiraslopes pic.twitter.com/s27PGkS49X
— European Society of Cardiology Journals (@ESC_Journals) February 14, 2023
Retrospective Study | Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome
15 Feb, 2023 | 15:40h | UTCPost-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome – Critical Care
RCT | Preliminary study on the effects of low-dose colchicine in patients undergoing non-CABG cardiac surgery
13 Feb, 2023 | 12:43h | UTC
Commentary on Twitter
✅Colchicine reduced cardiac injury after cardiac surgery
132 pts randomized to
?0.5 mg of colchicine or placebo in the perioperative periodColchicine compared with placebo
Cardiac makers⬇️
Atrial fibrillation⬇️ (few events, though)?https://t.co/c2mZmvj6kQ#CardioTwitter pic.twitter.com/N3DUjr1WsB
— Yuki Kotani, MD | 小谷 祐樹 (@YukiKotani5) February 8, 2023
Consensus Statement | Development of an Enhanced Recovery After Surgery (ERAS) surgical safety checklist
10 Feb, 2023 | 14:03h | UTC
Commentary from the author on Twitter (thread – click for more)
The @WHO Surgical Safety Checklist and the @ErasSociety guidelines come together.?
#ERAS teams can leverage 2 tools in 1 to improve care in critical perioperative communication moments https://t.co/EaXYyj7b56
via @JAMANetworkOpen part of @JAMANetwork pic.twitter.com/WHJMjThubO— Mary Brindle (@MaryEBrindle) February 8, 2023
RCT | Nighttime dexmedetomidine for delirium prevention in non-mechanically ventilated patients after cardiac surgery
1 Feb, 2023 | 12:58h | UTC
M-A | Colchicine for prevention of post-operative atrial fibrillation
27 Jan, 2023 | 12:03h | UTC
M-A | Effects of ultrasound-guided regional anesthesia in cardiac surgery
20 Jan, 2023 | 14:35h | UTC